INTRODUCTION
An environment isan external surrounding that
influences the health.
Therapeutic environment is environment which is
safe and conductive for the implementation of therapies
for the patients. Patient may have different kinds of
disabilities, whatever may be the disabilities, the patient
has to be protected from injury.
3.
SAFETY
Safety is definedas freedom from psychological and
physical injury which is essential for the well being and
survival of clients
4.
Factors affecting physicalenvironment
•There are few factors which are essential for the well
being of the patients.
Temperature – set the room temperature according
to patient choice, most suitable temp range
between 68 degree and 72 degree.
5.
Factors affecting physicalenvironment
Humidity– As humidity increases, the individual suffers
more from perspiration. In disease conditions like asthma,
a relative humidity of 10-20% is comfortable for patients.
• Noise– it is defined as the wrong sound in wrong place at
the wrong time. Recommended maximum sound level is
85dB. Beyond this level can cause physical and
psychological disturbances for the patient.
6.
Factors affecting physicalenvironment
Air movement/ ventilation--- Adequate ventilation--
maintain proper humidity and fresh air circulation.
Lighting– Adequate lighting needs to be maintained
during day and night in the patient’s room. Bright light
should be avoided because this make eye irritation of
some patients.
7.
Factors affecting physicalenvironment
•Purity of air-- Air must be free of harmful gases, dust
particles and micro organisms. For ex– Location of
patients rooms/ wards should be away from critical
care areas, procedure rooms or any entrance area.
Cross ventilation and adequate space between patient
beds. Cigarette smoking should be strictly avoided.
Allow natural entry of sunlight to enhance the positive
mood of the patients.
8.
Factors affecting physicalenvironment
•Odors– Adequate ventilation can maintain the good
odour in the room. Always empty and rinse urinals
and bedpans and keep the toilet commodes flushed
out promptly. Room deodorizes may help to remove
the unpleasant odors. Cigarette smoking is usually
strictly prohibited.
9.
Factors affecting physicalenvironment
•Pest control--- hospital is a place filled with lot of
people coming and going at virtually all hours of the
day– this creates a perfect environment for pests to
grow such as cockroaches, bed bugs, flies etc.
Rodents and other bugs can crawl into hospitals
through holes , cracks or gaps in roofs or walls. Once
inside these pests can feed on food found in the
garbage , kitchen and cafeteria.
10.
Factors affecting physicalenvironment
So it is very essential to keep a pest control team in the
hospital to make the environment become protected
from these germs. Periodic assessment and
maintenance should be done according to the need of
the area.
11.
Role of Nursein providing safe and clean
environment
Protection of patients from various injuries include:
Floors--- non slippery– highly polished with
uncovered rugs– absence of spillage or leakage on the
floor-- in case of spillage ; clean the floor
immediately.
Walls and floor of wards– non absorbent, non
porous, shock absorbing, attractive and fire resistant,
durable and easy to clean and damp proof.
12.
•Patients room shouldhave adequate ventilation,
lighting, natural ventilation, safe drinking water facility
with good drainage system. Patients room shd be free
from arthropods, vermin and animal pests.
13.
ROLE OF NURSE
•Keepsufficient space between patient’s bed.
Bath rooms
It shd be cleaned several times a day to prevent falls.
Keeping grab bars around tubs and toilet to keep
patients have grip.
Adequate lighting in the toilet is essential.
14.
ROLE OF NURSE
•Alwayskeep side rails of bed , especially
children, old age, disoriented unconscious from
falling.
•Rails of stair case is needed to protect the
patients.
•Electrical equipment shd be checked on daily
basis to prevent electrocution.
15.
ROLE OF NURSE
•Adequatepest control measures.
•Arrange the furniture and other equipment in
the wards properly.
•Stretchers and wheel chair shd be in good
working condition.
16.
REDUCTION OF PHYSICALHAZARDS
The envt should be safe for the patient and his attendants.
S--- Sense the error
A---Act to prevent it
F---Follow safety guidelines
E---Enquire into accidents // deaths
T---Take appropriate remedial measure
Y---Your responsibility
17.
REDUCTION OF PHYSICALHAZARDS
• FIRE– FIRE RELATED DEATHS & INJURIES AT RESIDENTIAL AREAS AND
WORK PLACE.
• SET FIRE PREVENTION – EMERGRNCY RESPONSE POLICIES– MOCK
DRILLS ETC
• ACCIDENTS– IS AN UNPLANNED EVENT THAT LEADING TO POTENTIAL
RISK FOR INJURY
18.
REDUCTION OF FIRE//THERMAL INJURY
Thermal injuries are injuries caused by heat. Burns may
occur from heat applications or fire accidents are
possible from smoking, defective wiring etc.
PREVENTIVE MEASURES
The hospital should have taken all precautions to
prevent fire mishaps.
Fire and safety team should be available 24*7.
19.
REDUCTION OF FIRE//THERMAL INJURY
Follow fire safety guidelines
Have fire extinguisher as per Fire and safety policy.
All staff should know how to handle the fire
extinguisher.
20.
REDUCTION OF FIRE//THERMAL INJURY
•Periodical training of fire and safety classes need
to arranged for all the employees to refresh their
knowledge about the emergency situation
handling.
•Nurses shd know the fire exit / escape routes
and they must be kept always open without any
lock system.
21.
REDUCTION OF FIRE//THERMAL INJURY
•Conducting fire mock drills at frequent intervals
to refresh the knowledge.
22.
REDUCTION OF FIRE/THERMAL INJURY
•Repair the malfunctioning electrical equipment to be
replaced or repaired immediately without failure.
•Be vigilant in using warmers, hot water bag, heating
pads and inhalers or giving oxygen inhalation to
prevent burns or fire mishaps.
24.
PREVENTION OF ACCIDENTSIN HEALTHCARE
SETTING
Preventing patient- inherent accidents
In this type patients are the primary cause of accidents.
Eg- self inflicted cuts, burns, injuries, ingestion of toxic chemicals, self
mutilation or fire setting etc; Poor cognitive state and seizure also may
lead to self inherent accidents.
Nurses must ensure that such patients are in safe environmental and
all harmful articles are removed from patient surroundings.
25.
PREVENTION OF ACCIDENTSIN HEALTHCARE
SETTING
• Prevention of equipment related accidents
nowadays highly advanced medical equipments are available.
Therefore, all health care professional need to know the basic
knowledge about these equipments. Identify the signs of
malfunctioning of devices.
Eg– inadequate vacuum in suction devices, errors in the infusion pump
or syringe pump flow rates, ventilator malfunctions , all these lead to
equipment related accidents. Also, failure to use protective belts or side
rails on stretchers and to lock wheel chair wheels can result in patient
injury and falls
26.
PREVENTION OF ACCIDENTSIN HEALTHCARE
SETTING
• Prevention of procedure related accidents
Follow correct steps of procedure while administering
medications, any kind of care giving to the patient, while
transferring or transporting, changing wound dressing,
applying comfort measures like heat and cold application etc.
27.
REDUCTION OF ACCIDENTS/INJURIES
•Reduction of mechanical injury– Ex– falls
•Reduction of chemical injury--- Always keep the
chemicals out of patients surrounding area..
especially from children..
28.
REDUCTION OF ACCIDENTS/INJURIES
•Reduction of radiation– Exposure to x -rays will
cause radiation hazard. These radiation injuries
can be prevented by the use of lead aprons and
other radiation precautions. Trained technicians
need to be appointed.
29.
REDUCTION OF BACTERIOLOGICINJURY
This caused by cross infection and it can be
prevented by using aseptic technique and by
following strict infection control measures.
30.
REDUCTION OF INJURYFROM ALLERGENS
Injuries from allergens are caused by medications,
insects, food, cosmetics etc. it can be prevented
by testing for allergies before administering
antibiotics or before an agent is applied on the
body.
31.
Filing a safetyevent report
An incident or accident that compromises the safety in a
hospital setting, requires the completion of a safety event
report by nurse on duty. This is a confidential report. Formerly
known as incident report. It objectively describes the event of
the incident.
32.
FALL RISK ASSESSMENTTOOL
•Assessing patient’s risk of fall is essential to determine
the specific needs and to determine the interventions
to prevent falls. It helps the nurse to assess for
potential risk before accidents or injuries result.
• The tool should be assessed on admission, or at
specific intervals or when there is changes in patient’s
health status.
33.
Categorization of fall
Fallscan be categorized as
• Accidental fall ( due to a spillage)
• Anticipated physiological fall ( a direct result of imbalanced
gait, medication side effects, or dementia)
• Un anticipated physiological fall ( due to stroke or seizure, or
a sudden collapse)
• Intentional falls ( occurs when patients act out behaviorally
with intent to fall )
34.
Risk factors ofFall
Intrinsic – (person based)
• Advanced age
• Muscle weakness
• Previous history falls
• Poor vision
• Gait and balance problems
• Postural hypotension
• Fear of falling
• Chronic conditions- stroke,
parkinsonism, Dm. dementia
Extrinsic ( environment based)
• Poor stair design
• Lack of stair railing
• Obstacles in the path
• Tripping hazards
• Dim lighting/glare
• Slippery or uneven surfaces
• Slippery footwear
• Psychoactive medications
• Improper use of assistive devices
36.
BASIS COMPONENTS OFFALL RISK
ASSESSMENT
This includes
Fall history
Physical examination
Medication analysis
Functional assessment
Laboratory tests and imaging
Environmental assessment
37.
BASIS COMPONENTS OFFALL RISK
ASSESSMENT
Fall History
Any previous history of fall, or any associated
symptoms like syncope, about to faint etc. Location of
fall, Activity induced fall, use of any assistive device if
using , all datas need to collect from patient or family.
Uses of eye glasses, ability to get up by self after the
fall, time of fall, any injuries or any medical attention
received.
38.
BASIS COMPONENTS OFFALL RISK
ASSESSMENT
Physical examination
•Three --quick gait , strength and balance tests are
•Timed up and go test-- TUG TEST
•The 30 second chair stand test
•The 4 stage balance test
39.
BASIS COMPONENTS OFFALL RISK
ASSESSMENT
Medication analysis
Usage of any psychoactive medications like anti
depressants, anti psychotics, sedatives and benzodiazepines
etc. This may lead to sedation, alteration in sensorium and
impairment of balance and gait.
Other medications such as anti hypertensives, diuretics
and nonsteroidal anti inflammatory drugs can also lead to
patient fall.
40.
BASIS COMPONENTS OFFALL RISK
ASSESSMENT
Functional Assessment
•This is based on asking questions about
difficulties with performing Basic activities of
Daily living and independent activities of Daily
living. The risk is depends on the functional
ability of the patient.
41.
contd….
•Eg– people whoare healthier are more likely to
fall on stairs, away from home, or during
displacing activities such as bending over,
reaching up etc. By contrast, people with
functional limitations are more likely to fall at
home during routine activities
42.
BASIS COMPONENTS OFFALL RISK
ASSESSMENT
Environmental assessment
•Identify any obstacles in the pathways, or on
stairs, unsupportive or ill-fitting fitting foot wear,
unsuitable assistive devices, in adequate lighting
and slippery surfaces.
• also identify the hazards outside the home such
as any cracked pavement or sloped yards.
BASIS COMPONENTS OFFALL RISK
ASSESSMENT
Laboratory test and imaging
•This include Thyroid stimulating hormone, vit
B12 level, CBC. 25 – hydroxy vitamin D LEVEL,
and other lab test if clinically indicated.
• A DUAL – energy Xray absorptiometry scan shd
be done if bone mineral density has not been
assessed.
45.
BASIS COMPONENTS OFFALL RISK
ASSESSMENT
•However, based on the need and degree of
injury
•CT, MRI of the brain may be indicated.
46.
Measures to preventfalls
Individualistic measures for fall prevention
•To support the role that calcium
supplementation and vit D play in promoting
skeletal health and can reduce the risk of fall.
•Regular exercise has a positive effect on bone
and muscle strength, balance and flexibility of
joints
47.
Measures to preventfalls
Preventing fall in Home
•By installing hand rails or grab rails in bath rooms
and on stairs
•Ensuring adequate lighting
•Discarding or repairing broken articles
48.
Contd…
•A complete homesafety survey is essential by
the home care nurse is beneficial to reduce the
risk. Identify the risk and dangers and notify the
family members.
49.
Measures to preventfalls
PREVENTING FALLS IN HOSPITALISED PATIENTS
•Age group– Geriatric patients, children, mental
status of the patient, uncontrolled body
movements, incontinence, pain, unsteady gait
nee d to assess carefully to avoid fall.
50.
SAFETY DEVICES
•Safety devicesrefers to an equipment that are
used to ensure the safety of the patients and the
healthcare envt.
•There are various devices are used for patient’s
safety in the hospital, such as restraints, side
rails, grab bars/ trapeze bars, splints,
Ambularms and non skid slippers.
51.
Safety devices contd….
•Accompanywith the patient who are old,
disoriented, children, unconscious or those with
locomotor disabilities.
•Special attention must be provide for non-
verbalized patients, assess their needs and
meets accordingly.
•Comfortable physical environment.
52.
Restraints
•Restraints are physicaland protective devices
employed to prevent a patient from harming himself
or others, to immobilize a part, to restrict the activity
and to promote a feeling of security in patients.
•The restraints are made up of linen, canvas, leather,
plastic metal or wood.
53.
Purpose of restraints
•Usefulin preventing injuries to patients or
others.
•Help to immobilize the part
•It gives safety and protection
•Helps to restrict the activity
•To prevent patient falling from bed or chair
54.
Types of Restraints
Physicalrestraints ( using external physical
equipment)
Chemical restraints ( Use of sedatives, anti
psychotic medications, anti depressants, and
anxiolytics)
Environmental restraints ( seclusion of the
patient, or secure the unit- a kind of isolation)
55.
Types of physicalrestraints
Extremity restraints/ Restraints of ankle, hands
•use wrist restraint and limb restraint
•It is used to prevent patient from harming
himself or others and also to prevent the patient
from removing any monitors used in his or her
treatment.
56.
•Wrap limb restraintaround wrist or ankle with
soft part towards the skin and secured it in
place by Velcro straps.
57.
Types of physicalrestraints
Elbow and knee restraints
•These are used to prevent the flexion of elbow
and knee.
58.
Types of physicalrestraints
Mitten restraints
• are used for children or confused patients in
order to prevent removing tubes, dressing ,
harming himself / others, scratching etc.
59.
Types of physicalrestraints
Chest restraints
•Are used for patients sitting on a wheel chair to
maintain his position and to prevent him from
falling.
60.
Types of physicalrestraints
Mummy restraints
•Used to restrict the movements of the limbs of
infants or children during any procedure.
61.
Guidelines/ principles forapplying restraints
Written order from physician
Restrain must be used only when it is
necessary to maintain the safety of patient
It should be applied smoothly without
obstructing blood flow , maintain normal
anatomical position.
62.
Guidelines…
Use appropriate/ correctsize restraint for
the patient.
Do not apply it over an intravenous line or
over any other devices.
Pad the skin or bony prominences if
needed before applying.
63.
Guidelines/ principles forapplying restraints
•Do not apply the restraint in an immobile body
part.
•It shd be released every 2 hrs or according to the
policy of the institution or whenever the patient
need. Perform range of motion exercises.
•Remove/ release it immediately if numbness ,
loss of sensation , or cyanosis are noted.
64.
Legal implications forthe use of restraints
•Be familiar with the institutional policies and
guidelines.
•Always check the written order of the Doctor..
•Apply only when it is necessary situation.
•Ensure patient safety while applying restraint
65.
Legal implications forthe use of restraints
•The patients family is also involved in the plan of
care before applying restraints in long term care
settings.
•It can never be applied for the convenience of
the staff.
•The healthcare providers can use restraints only
to ensure the physical safety of the clients.
66.
Legal implications forthe use of restraints
•Obtain a consent for the application of
restraint from patient or the family member.
•Keep in mind that the principle of least
restriction.
•Periodically re evaluate the need for the
restraint.
67.
Other safety Devices
Side rails– attached to both sides of
patient’s bed, it must be kept up for all the
patients with out any fail.
68.
Other safety Devices
Safetybelts
these are made up of materials which are not conduct
electricity.
These safety belts are used on stretchers and an operation
tables in order to prevent the patient from falling.
The belt goes around the patient’s waist, is attached to longer
belt which is then tied to the bed frame under the mattress.
70.
Other safety Devices
Ambularm
Isa new concept of fall prevention.
It is a device that patient wears on the leg which signals
when the leg is in a dependent position such as over the
siderail or on the floor. It is most effective as part of a
complete fall- prevention programme and is relatively
inexpensive. Whenever the patient moves towards a
standing , kneeling or crawling position, the alarm sounds
automatically, which need immediate assistance.
Other safety Devices
Grabbars
are safety devices designed to enable a person
to maintain balance , lessen fatigue while
standing, hold some of their weight while
maneuvering, or have some thing to grab onto in
case of a slip or fall.
Other safety Devices
Non-skid slippers
are ideal for patients to help prevent falls by
preventing slipping or skidding. They can assist
patients on wet or slippery surfaces
75.
CONCLUSION
Thorough physical assessmentof the patient is
very crucial during the care of the patient. This
can limit the fall during hospitalization, improve
the quality of life , encourage the patient or
family to follow the safety measures in both
home and hospital. Explain the family about the
importance of using Restraints and the care of
restraints during hospitalization.
76.
Bibliography
•Nursing Foundation forBsc Nursing – Dr
Valsamma Joseph, susamma Varghese, Frontline
publications, page no- 227-236
•Text book of nursing foundation for bsc nursing
students, by Jyoti kathwal, page no- 245-269
